脊髓造影及電腦斷層攝影對於臨床未確定位置之壓迫性脊髓病的診斷

Myelography & CT-Myelography for the Diagnosis of Compressive Myelopathy with Clinically Uncertain Level

沈戊忠(Wu-Chung Shen) ； 楊建芳(Nien-Tsu Han) ； 韓念祖(Chien-Fang Yang) ； 張遵(Tusen Chang)

《中華放射線醫學雜誌》 11卷4期 (1986/12) Pp. 279-289

摘要

臨床上懷疑有壓迫性脊髓病變，但一般X光片並無發現，我們視之為臨床未確定位置之壓迫性背髓病變。此類病患最好的診斷方法是先以水溶性對比劑做脊髓造影，可以根據對比劑受阻塞或壓迫等跡象精確的找到病變位置，然後再以CT對準脊髓造影所指示之病變位置做掃描，CT可以馬上診斷病變的原因是腫瘤，HIVD，骨刺、膿瘍或血塊等等。也可觀察脊髓受壓迫引起變形，移位或萎縮。因此脊髓造影搭配CT-脊髓造影是診斷臨床上未確定位置脊髓病變之最適當檢查方法。

並列摘要

From October 1984 to March 1986, 70 cases of clinically suspected compressive myelopathy were sent to the Radiological Department for both myelographic and CT myelographic examinations. No abnormal change in areas corresponding to the clinical level was found. in plain spine film or nuclear medicine study. These cases were regarded as clinically unknown level. Patients with compressive myelopathy confirmed by plain spine film or nuclear medicine were regarded as clinically known level and were excluded from this study.
Water soluble myelography was performed first, using metrizamide or iopamidol. In 33 cases had positive findings corresponding to the clinical symptoms. CT myelography was done 1-4 hours after the myelography, which disclosed spinal tumors in 14 cases, cervical HIVD in 13 cases, cervical hematoma in 2 cases, abscess in 1 case, post traumatic cord swelling in 2 case, and post irradiation cord swelling in 1 case. Negative findings in myelography were found in 37 cases, of them 7 had a spinal injury history. CT-myelography was done six hours after the myelogram, which revealed post-traumatic spinal cord cyst in 3 cases, posttraumatic cord atrophy in 1 case. The remaining 30 negative finding cases were sent back to the neurologist for reevaluation of the clinical symptoms. Fifteen cases were withdrawn for compressive myelopathy after reevaluation; the other fifteen cases were returned to the Radiological Department again without change their impression. Myodial myelographies were performed for rule out the possibility of arachnoid cyst. Eight out of the 15 cases were diagnosed as arachnoid cysts and 6 were confirmed by surgical intervention (no false positive). Finally, no abnormal finding was obtained in 7 cases after repeated oil contrast myelogram.
Although CT scan depicts the spinal disease very clearly, CT myelography is essential for the diagnosis of compressive myelopathy because it can even disclose the spinal cord by opacifying the surrounding CSF. However, in most instances, it is inconvenient to apply CT myelography directly because the true pathological level is not corresponding to the sensory level and can not be defined by clinical symptoms and signs only. So we suggest that in treating myelopathy, water soluble contrast meylography should be done first to locate and define the pathological level, and then followed by CT-myelography.